I recently had a colleague share a video about ADHD by the YouTuber Sasha Hamdani, MD.
Dr. Hamdani’s video can be viewed here.
In this video, Dr. Hamdani describes a research study where researchers did brain scans of 446 children with ADHD (primarily boys) and split them into groups based on brain connectivity patterns alone. The children fell into three groups, much like how we currently diagnose ADHD: inattentive, hyperactive/impulsive, and combined. The curious thing was not the labels, but what was happening in the brains of each major grouping.
Per her video, in the combined-presentation youth, researchers identified differences in connectivity involving areas of the brain associated with emotional regulation, decision-making, and the ability to pause and consider our responses. Researchers described this group as having a severe combined presentation with emotional dysregulation. In fact, the findings suggested that emotional dysregulation was a particularly important feature of this group. Interestingly, emotional dysregulation isn’t explicitly included in the DSM’s core diagnostic criteria for ADHD, which focus primarily on patterns of inattention, hyperactivity, and impulsivity.
Researchers later found similar patterns in a separate group of children.
This research can be classified as “emerging” at best. There are clear limitations to drawing general conclusions when you’re looking at children only, at largely boys, etc, but the results are definitely interesting.
As a high-functioning adult woman, therapist, and mother to a neurospicy adult, I found this study helped me break through a stuck point. I have, for years, been looking for what my own neurodivergence might be. After all, the apple doesn’t fall far from the tree.
I’m pretty sure I have an auditory processing disorder (I joke that I am apt to believe people are saying the most outlandish things because my brain just can’t pick out words in certain environments, so it makes things up), and I have also claimed I was “ADHD lite.”
I never wanted to appropriate ADHD, AND I just never really matched the full criteria for a diagnosis, but I sure felt like I got a lot of what people were describing. And some people who have worked closely with me have questioned if I had ADHD at times.
This video’s combined-presentation group helped me take another timid step toward understanding myself through this lens. In the third group, the emotional regulation heavy grouping, I started thinking more about that pesky little thing we call rejection sensitive dysphoria, which, when we perceive or become concerned about judgment or rejection, takes up “all the airwaves” in our brain, making it harder to function.
Focus on tasks becomes very difficult when we are experiencing RSD because our emotional response to feeling cast out of the herd takes priority over focusing on, for example, the chapter I’m reading for school.
This is a familiar feeling to me. I completely relate to RSD and it’s impact on focus. And while emotional dysregulation alone doesn’t mean I (or anyone) has ADHD, learning more about its role in ADHD makes me wonder whether there’s something about my own experience that the current diagnostic criteria don’t fully capture—the space where some of us fall through the diagnostic cracks.
So, in the end, I still don’t know if ADHD is a fit for me, but I’m slowly building a case for exploring it further. I don’t personally feel a need to pursue a formal diagnosis right now, though I absolutely recognize its value. For some people, a diagnosis offers profound relief and self-understanding. It can also open doors to treatment, accommodations, and support that might otherwise be difficult to access. For others, learning about their patterns and finding ways to work with their nervous system may be enough for where they are in life.
I don’t think there’s one right choice for everyone. I do think we deserve the freedom to explore our experiences, seek answers when we need them, and decide what kind of support is useful to us.
Here’s where things get particularly interesting to me, though. ADHD or not, I’ve figured a lot of my way through this because I’ve spent so much time on emotional regulation and learning how to work with what I always thought of as my perfectionism and avoidance tactics.
Dr. Hamdani describes being a highly capable, professionally successful woman who has found ways to work around many of her executive functioning challenges (same). She can organize her life, delegate tasks, and find ways to get things done (same). But when something emotionally overwhelming happens, all those clever workarounds can go right out the window, and she finds herself struggling to focus (same, girl, same).
She describes receiving criticism about her work and having an emotional response so intense that it essentially hijacked her ability to function. Intellectually, she could understand what was happening. She could recognize that the criticism wasn’t necessarily a threat. But knowing that didn’t make the emotional response disappear.
And then came the second layer of suffering.
She began questioning herself. Was she being dramatic? Was she too sensitive? Shouldn’t she be able to handle this better?
I am curious—does this sound familiar to any of you? It does to me.
We are so quick to interpret emotional dysregulation as a character flaw. We are the people who are too much: too sensitive, too emotional, too undisciplined, too reactive. Shoot, I have recommended parenting books to clients that describe the profile of their child as being “too.”
But what if the problem isn’t that someone is choosing to make a mountain out of a molehill?
What if their nervous system is genuinely experiencing that molehill as a mountain?
First of all, that shifts our response to them, right? Compassion for them. For us.
And what if understanding why it’s happening could help us respond more effectively? After all, the pathways to emotional dysregulation aren’t necessarily the same for someone with ADHD, OCD, anxiety, or a history of trauma. Understanding what’s driving the response might change how we work with it. Different conditions and experiences can involve different patterns of brain functioning, and understanding those differences may help us find more effective ways to support regulation.
Think about that for a moment.
We tend to judge ourselves and others by what we can see. We see the person who overreacts to criticism. We see the person who can’t seem to get started on a task. We see the person who shuts down during conflict or becomes overwhelmed by something that seems relatively minor to someone else.
What we don’t see is the internal experience that research like this is beginning to help us understand.
We don’t see just how hard someone is working to keep themselves regulated when their nervous system may be processing the experience very differently from our own! We also don’t see just how thoroughly their attention has been hijacked by their emotional experience.
Sometimes that disruption doesn’t resolve in a few minutes like we want. The emotional response may subside, but the fallout—exhaustion, lost momentum, shame, and the effort of finding our footing again—can linger for hours, days, or sometimes even longer.
We don’t see the shame creep in and how that further disconnects us.
So now we’re not just dealing with our original experience, we’re dealing with our reaction to our reaction, and we’re embarrassed that something so seemingly small has derailed our day. Self-criticism is not a pathway to settling a nervous system (quite the opposite!) so we’ve just added another layer of distress to an already overwhelmed system.
This is one of the reasons I’m so passionate about embodied approaches to personal growth and healing. We cannot always think our way out of a nervous system response. In fact, I’d go so far as to say that we rarely can think our way out. Often, we need to work with the body, with our capacity to recognize and tolerate emotional experiences, and with the conditions that help us return to a greater sense of safety and flexibility.
And this is where my own experience has become so valuable. I may not know whether ADHD is the right diagnosis for me, but I have learned to recognize and work with my experiences of rejection sensitivity. I’ve learned to listen to my nervous system, to notice when it’s sounding the alarm, and to respond with care rather than immediately believing every story my overwhelmed brain wants to tell me.
That understanding has helped me find my footing without needing to actually know if I am neurodivergent first.
All of this begins with curiosity.
Instead of asking, “What’s wrong with me that I can’t handle this?” we might ask, “What’s happening in my system right now? And can I bring more compassion to just how real this experience is to me and my system?”
Instead of assuming a child or loved one is being difficult, we might wonder what is making this moment difficult for them. (Oh, how I dream of the day this becomes our approach with others and with ourselves).
That doesn’t mean our behavior doesn’t matter. It doesn’t mean we’re excused from taking responsibility for how we treat others. And it certainly doesn’t mean that every intense emotional response is evidence of ADHD.
But it does mean that understanding what’s happening underneath a behavior can open up possibilities that judgment never will.
Love,
Renee